Healthcare Provider Details

I. General information

NPI: 1073063897
Provider Name (Legal Business Name): ENTROPY BEHAVIOR SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 21ST ST
SACRAMENTO CA
95818-1710
US

IV. Provider business mailing address

2214 21ST ST
SACRAMENTO CA
95818-1710
US

V. Phone/Fax

Practice location:
  • Phone: 916-623-5325
  • Fax:
Mailing address:
  • Phone: 916-623-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JOEL BOSSERMAN
Title or Position: PRESIDENT
Credential: M.A., BCBA
Phone: 916-936-1663